Dr. Yu on Treatment Intensification in Metastatic Castration-Sensitive Prostate Cancer

Evan Y. Yu, MD, professor, Department of Medicine, Division of Oncology, University of Washington, Seattle Cancer Care Alliance, discusses treatment intensification in patients with metastatic castration-sensitive prostate cancer.

The CHAARTED and STAMPEDE trials showed that 6 cycles of docetaxel when added to androgen deprivation therapy (ADT) led to a dramatic improvement in survival. In treating metastatic disease, Yu states that there is clearly a benefit with docetaxel, especially in patients with high-volume disease.

The LATITUDE and STAMPEDE trials showed that adding abiraterone acetate (Zytiga) to standard ADT also led to a dramatic survival benefit. Physicians do not yet know if one agent is better than another, but Yu states that he uses abiraterone for patients with low-volume disease. Yu states that he offers both agents to patients with high-volume disease, recognizing dosing, duration, and financial toxicity concerns.

There are many clinical trials with combination therapies, and investigators are considering doing metastasis-directed therapy by surgically removing oligometastatic disease or through radiation. There are also studies looking at removing the primary lesion of the prostate or providing radiation to the prostate. Novel next-generation imaging mechanisms such as fluciclovine-PET or prostate-specific membrane antigen-PET are also being studied as a potential means of metastasis-directed therapy.